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Chapter 14: Health
• Mental Health: Disorders such as anxiety and depression, and other indicators of psychological well-
being, can be both exacerbated and repaired by our relationships with others.
• Health Psychology: The application of psychology to the promotion of physical health and the
prevention and treatment of illness, by psychologists from various specializations.
• Health is a joint product of biological, psychological, and social factors. Today’s most deadly diseases are
preventable through changes in lifestyle, outlook, and behaviour.
• 1) Stress: what causes it, what it does to the body, and how we appraise situations to cope with them.
• 2) Social influences on treatment and prevention of disease.
Personal and Situational Background Factors
The Stress-and-Coping Process
Potentially stressful event
• 3) Pursuit of happiness and life satisfaction.
STRESS & HEALTH
• Stress: An unpleasant state of arousal in which people perceive the demands of an event as taxing, or
exceeding their ability to cope by satisfying or altering those demands.
• Top stressors typically related to money, work, housing, and job stability. Stress results in irritability,
fatigue, nervousness, lack of energy and motivation, depression, headaches, and physical tension.
• The stress-and-coping process is an ongoing transaction between a person and their environment.
o Our subjective appraisal (process of making judgements about demands of potentially stressful
events and ability to meet those demands) determines how we will experience the stress, and what
coping strategies we use (efforts to reduce stress by thoughts, feelings, and behaviours).
o People may also take proactive steps to keep a potentially stressful event from occurring.
WHAT CAUSES STRESS?
• Stressors: Any source of stress.
Crises and Catastrophes
• Post Traumatic Stress Disorder (PTSD): A condition in which a person experiences enduring physical
and psychological symptoms (recurring anxiety, sleeplessness, nightmares, flashbacks, attention
problems, and social withdrawal) after an extremely stressful event, such as war.
o Exposure to war also results in PTSD symptoms in civilians, especially for those in minority with
fewer coping resources to turn to (Palestinians in Israel).
o Also caused by witnessing murder or injury, death of loved one, life-threatening accidents, natural
disasters, and assault. Symptoms often last for many years.
Major Life Events
• Change itself can cause stress by forcing us to adapt to new circumstances: they may be negative
(getting hurt, divorced, or fired) or positive (getting married, promoted, or having a baby).
• Social Readjustment Rating Scale (SRRS) has checklist of 43 major life events, each assigned a
numerical value based on amount of readjustment it requires. Page 2 of9
• Change is not entirely predictive of stress and future health: link between positive “stressors” and illness
complicated, and impact of change depends on person and how they interpret the change.
Microstressors: Hassles of Everyday Life
• Microstressors are hassles such as loud noise, extreme heat or cold, gas prices, waiting in lines, losing
objects, and bad work days. The accumulation of daily hassles contribute more to illness than do major
• Burn Out: Prolonged response to occupational stress characterized by emotional exhaustion, cynicism,
disengagement, and lack of personal accomplishment. This is particularly difficult for those in human-
service professions under relentless pressures, such as teachers, doctors, and social workers.
• Commuting is also a form of daily stress: the longer the commute, the more stress reported and higher
• Financial pressures of tight budget and difficulty playing bills cause distress and conflict.
HOW DOES STRESS AFFECT THE BODY?
• Hans Selye: Noticed patients with similar symptoms, which he reproduced by exposing lab rats to
various stressors. These stressors produced similar physiological responses: enlarged adrenal glands,
shrunken lymph nodes, and stomach ulcers.
The General Adaptation Syndrome
• General Adaptation Syndrome: A three-stage process by which the body responds to stress.
o 1) Alarm: Initiation recognition of threat sparks physiological arousal. The body mobilizes all its
resources to ward off the threat, inhibiting growth, digestion, and operation of the immune system.
o 2) Resistance: The body remains aroused and on the alert. There is continued release of stress
hormones and activation of local defenses.
o 3) Exhaustion: If stress persists for a prolonged period of time, overuse causes other systems to
break down, increasing risk of illness – long-term stress compromises health and well-being.
• Evolutionarily, psychological stress is a recent innovation – the response designed for acute physical
emergencies is now being used too often and for too long for other human events.
• Physiological symptoms: sympathetic nervous system activated, adrenaline secreted, heart rate
increases and arousal heightened. Liver pours sugar into blood for energy, pupils dilate to focus,
breathing speeds up for oxygen, perspiration increases, blood clots form faster, and digestion slow down.
• Men exhibit fight-or-flight, while women exhibit tend-and-befriend: women adapt to stress by caring for
children (nurturing) and seeking out others who might help (affiliating); elevated levels of hormone
oxytocin increases tendency to seek out social contact.
What Stress Does to the Heart
• Coronary Heart Disease (CHD): Narrowing of coronary vessels that carry oxygen and nutrients to heart
muscle. It is leading cause of death in U.S. among both men and women; heart attack with blockage of
blood supply to heart often results, and 1/3 do not survive.
o Top 3 risk factors: hypertension (high blood pressure), smoking, and high cholesterol. 4 major risk
factor is psychological stress.
• Type A Personality: Pattern of behaviour characterized by extremes of competitive striving for
achievement, a sense of time urgency, hostility, and aggression (Friedman and Rosenman, 1956). Type
B Personality: Easygoing, relaxed, and laid back.
• Type A behaviour pattern is coronary-prone, considered a CHD risk factor. However, issues about
measurement: Page 3 of9
o Strength of correlation between Type A behaviour and CHD depends on how people are
diagnosed. Questionnaires are not as predictive as in-depth interviews – type A pattern is more
evident from behaviour than from self-reports.
• The primary factor is hostility: resentment, cynicism, suspicion, and mistrust. People chronically in a
negative emotional state and quick to explode are besieged by stress; even if anger is suppressed,
hypertension is likely to develop and lead to CHD.
o Hostile people are less health-conscious. They are also physiologically reactive, exhibiting more
intense arousal in tense social situation . Further studies in psychocardiology.
What Stress Does to the Immune System
• Immune System: A biological surveillance system that detects and destroys “nonself” substances that
invade the body – bacteria, viruses, parasites, and fungi. It includes specialized lymphocytes that
circulate that secrete chemical antibodies, as well as large scavenger cells. This system is continually
• Psychoneuroimmunology (PNI): Subfield examining links among psychological factors, the brain and
nervous system, and the immune system. Various methods:
o 1) Taking blood samples of subjects exposed to varying degrees of stress, and count number of
circulating lymphocytes and white blood cells
o 2) Extract blood, add cancerous tumour cells, and measure extent to which natural killer cells are
able to destroy the tumours
o 3) “Challenge” the living organism by injecting a foreign agent into the skin, and measuring amount
of swelling at site of injection. The more swelling, the more potent the immune reaction.
• Animals exposed to noise and overcrowding, and primates and humans who had lost companions exhibit
drop in immune cell activity. The more positive events participated in a given day, the more antibody
produced to a novel substance; the more negative events, the less antibody.
Negative Emotional States
Weakened immune system
• Two ways for psychological states to affect immune system. People under stress may perform unhealthy
behaviours like smoking, alcohol use, sleeping and exercising less, and eating poorer diets. Stress also
triggers release of adrenaline and other stress hormones, which suppress immune cell activity.
The Links Between Stress and Illness
• Cohen (1993): Subjects fill out questionnaires about stressful events in life, and receive a blood test.
Some are assigned to a control placebo, while others receive a cold virus. Of those exposed, 82%
became infected, and 46% of those infected caught a cold.
o High-stress subjects more vulnerable to catching contagious illness than low-stress subjects.
o Chronic stressors (unemployment, ongoing marital problems) are more toxic than short-term
• Personal characteristics can buffer against adverse health effects: more sociable people, people who see
themselves positively on the socioeconomic status ladder relative to others – regardless of actual status.
• These psychological factors have similar effects on serious illnesses, including the spread of cancer – in
PROCESSES OF APPRAISAL Page 4 of9
Attributions and Explanatory Styles
• Depression: Mood disorder characterized by sadness, pessimism, apathy, disturbances in sleeping and
eating patterns and reduced sex drive. Twice as many women as men seek treatment for depression.
• Learned Helplessness (Seligman, 1975): A phenomenon in which experience with an uncontrollable
event creates passive behaviour in the face of subsequent threats to well-being, based on acquired
expectation that one cannot control important outcomes. Prolonged exposure to uncontrollable events
leads to apathy, loss of motivation, pessimism, and ultimately depression.
• Depressive Explanatory Style: Habitual tendency to attribute negative events to causes that are
internal (“it’s my fault”), stable (“it will not change”), and global (“it is in all parts of my life”). These
negative self-attributions lead to hopelessness and depression.
The Human Capacity for Resilience
• Hardiness (Kobasa): People differ in reaction to stress, and resilience is a buffer against stress.
o 1) Commitment: Sense of purpose with regard to one’s work, family, and other domains
o 2) Challenge: Openness to new experiences and desire to embrace challenge
o 3) Control: Belief that one has power to influence important future outcomes
• Resilience may be more common in men, among those in the population majority, and among those with
more education, money, and social support from friends.
• Perception of control important for hardiness, especially for those whose lives are largely regulated by
other factors, such as the elderly or patients with a chronic illness.
• Self-efficacy: Person’s belief about whether their competence: whether they are capable of the specific
behaviour required to produce a desired outcome in a given situation. Self-efficacy varies between tasks
• Self-efficacy is necessary for persisting in the face of failure and eventual success. Those with high self-
efficacy are more likely to do the necessary behaviours to maintain mental and physical health, and
• Past attributions and current perceptions of control have role in outlook. Optimism characterized by
nondepressive explanatory style: blaming failure on external, temporary, and specific factors and credit
successes to internal, permanent, and global factors.
• Positive correlation between optimism and health; optimists take active problem-focused approach to
coping with stress and other threats.
o Longitudinal study: Those who scored as more optimistic when young later in life are healthier
• Positive expectations can be self-fulfilling: those high in hopelessness more likely to have died of various
causes, especially from cancer and cardiovascular diseases
• Attributions, perceptions of control, optimism, and other sources of resilience are important – but not the
sole determinants of health.
• Drawbacks to positive thinking if it leads us to perceive the world in unrealistic ways: social
repercussions of seeing oneself fin overly positive ways, overly high control expectations can lead to
depression when outcomes are negative.
WAYS OF COPING WITH STRESS Page 5 of 9
• People have many ways to cope with stress depending on the person and the stressor. Using
multidimensional questionnaire, 12 distinct methods of coping established with two general types:
o Problem-Focused Coping: Cognitive and behaviour efforts to alter a stressful situation by
overcoming the source of the problem.
o Emotion-Focused Coping: Cognitive and behavioural efforts to manage emotional reaction of
distress produced by the stressful situation, rather than chan